Utilization Manager-Duke Raleigh
Company: Duke Health
Location: Raleigh
Posted on: January 27, 2023
|
|
Job Description:
Duke Raleigh Hospital Duke Raleigh Hospital offers the latest in
care and technology in a patient-friendly setting. It has been an
important part of Duke Health since 1998 and has served Wake County
for more than 35 years, employing more than 2,000 teammembers. The
hospital provides 186 inpatient beds and a comprehensive array of
services, including the Duke Raleigh Cancer Center, Duke Raleigh
Orthopedic and Spine Center, cardiovascular services, neurosciences
including the Duke Raleigh Skull Base and Cerebrovascular Center,
advanced digestive care, disease management and prevention, wound
healing, outpatient imaging, intensive and progressive care, pain
clinic, same-day surgery, emergency department and community
outreach and education programs. U.S.News & World Report ranked
Duke Raleigh Hospital as high performing in orthopaedics and five
adult procedures/conditions: chronic obstructive pulmonary disease
(COPD), heart failure, kidney failure, lung cancer surgery, and
stroke.
Duke Nursing Highlights:
Assesses for accuracy in the assignment of patient class (status)
to reflect congruence with clinical condition, physician intent,
and utilization review outcomes with current rules and regulatory
requirements. Supports the medical chart audit process by ensuring
accurate, timely, and informative clinical review documentation
that supports the medical necessity/level of care. Supports denials
management by documenting activities related to denials
adjudication according to departmental guidelines and actively
works to overturn threatened denial activities. Complies with
current rules and regulatory requirements pertaining to utilization
management. Initiates actions to obtain appropriate determinations.
Collaborates with members of the healthcare team to address,
understand, and mitigate excess/avoidable days. Serves as primary
source of consultation for issues related to patient class (status)
determination.
Work Performed
Work Hours
4/10 hour shift with every other weekend
Knowledge, Skills and Abilities
Level Characteristics
N/A
Minimum Qualifications
Education
BSN required
Experience
Minimum of three years recent acute clinical practice or related
health care experience.
Degrees, Licensures, Certifications
Requires Case Management Certification (ACM, CCM or ANCC) within 2
years of hire. BSN required and must have current or compact RN
licensure in state of NC. BLS certification required.
Job Code: UTILIZATION MANAGER
Job Level: G1
Duke is an Affirmative Action/Equal Opportunity Employer committed
to providing employment opportunity without regard to an
individual's age, color, disability, gender, gender expression,
gender identity, genetic information, national origin, race,
religion, sex, sexual orientation, or veteran status.
Duke aspires to create a community built on collaboration,
innovation, creativity, and belonging. Our collective success
depends on the robust exchange of ideas-an exchange that is best
when the rich diversity of our perspectives, backgrounds, and
experiences flourishes. To achieve this exchange, it is essential
that all members of the community feel secure and welcome, that the
contributions of all individuals are respected, and that all voices
are heard. All members of our community have a responsibility to
uphold these values.
Essential Physical Job Functions: Certain jobs at Duke University
and Duke University Health System may include essential job
functions that require specific physical and/or mental abilities.
Additional information and provision for requests for reasonable
accommodation will be provided by each hiring department.
Keywords: Duke Health, Raleigh , Utilization Manager-Duke Raleigh, Executive , Raleigh, North Carolina
Click
here to apply!
|